Instruments for the extraction of foreign bodies



E. DORMIA 2,943,626 INSTRUMENTS FOR THE EXTRACTION OF FOREIGN BODIESJuly 5, 1960 Filed Jan. 28, 1-958 lvli. l n

)NVENTOR ENR/CO DORM/A TTORNEY United States Patent INSTRUMENTS FOR THEEXTRACTION OF FOREIGN BODIES Enrico Dormia, 8 Via Poliziano, Milan,Italy Filed Jan. 28, 1958, Ser. No. 711,585

Claims priority, application Italy Jan. 31, 1957 8 Claims. (Cl. 128-328)The present invention has for its object an instrument enabling foreignbodies of any kind which may be located "in passages in the human bodyor in the bodies of animals to be extracted.

This instrument has a special, although not exclusive, application inthe extraction of calculi in the ureters. Hitherto, 'for the purpose ofefliecting such extractions by natural methods, instruments have beenavailable the efficiency of which is limited and the frequent lack ofsuccess of which makes it necessary to resort to surgical interventionof a certain serious character. The instrument according to the presentinvention enables this drawback to be disposed of and it enables suchextractions to be effected by natural methods-for example, in the caseof a ureteral calculus, by working through the bladder.

The instrument according to the invention is characterized by the factthat it comprises a flexible tube containing a control cable, the saidcable being extended, at one of the ends of the tube, by a set offlexible elements which are connected to one another at their ends andwhich are retracted into the tube in one position of the control cableand emerge from the tube, spreading apart as they do so, in anotherposition of the control cable, thus forming a kind of basket whichenables the body to be extracted to be gripped and brought out.

i The flexible elements may be wires or narrow bands. They may consistof any material, for instance of ordinary steel or stainless steel oragain of metal covered with plastic material resistant to sterilizationtemperatures.

The flexible elements may assume any form in the spread position. Theymay, for example, extend in radial planes passing through the axis ofthe tube, but, more advantageously, they may take, between the exit ofthe tube and the point at which they meet again, a helical or athree-dimensional spiral form, which has proved to be extremelyadvantageous for obtaining a good grip on the body to be extracted. Infact, with the classical devices (hooks, loops, etc), the points ofcontact of the prehensile system with the wall of the body passageduring the descending motion amount to a rectilinear tracing. On theother hand, with a helical form, each of the coiled wires comes intocontact with a large portion of the Wall of the body passage which isthus swept by the parts of the basket so that the body to be extractedis inevitably booked by a wire and imprisoned.

The helical form of the wires presents the further advantage that itmakes the detachment of the body to be removed less brutal and lesspainful. The foreign body is not attacked direct from the top butobliquely, tangentially. It is thus subjected to a more effective andless painful progressive thrust so that a tearing of the passage wall inthe case of embedded bodies is avoided.

The accompanying figures show, by way of example, various possible formsof embodiment of the instrument according to the invention.

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Figure 1 is a complete view of the instrument, the flexible elementsbeing retracted within the tube;

Figure 2 shows the instrument with the flexible elements emerging fromthe tube and spread apart;

Figure 3 shows on a larger scale the end of the tube and the spreadelements;

Figure 4 is a diagram of the operation of extracting a ureteralcalculus; and finally,

Figure 5 shows a form of construction of the instrument comprisinghelical elements.

In the figures, 1 denotes the flexible tube, constituted for instance,by a ureteral catheter of the conventional type. Through the inside ofthis tube there passes a steel control cable 3. The tube 1 is provided,close to its near end 1, with a kind of head 2 and the cable 3 isprovided at its end 3' with a similar head 5. At its remote end 3"opposite the head 5, the cable 3 is extended by a cylinder 7 slidinginside the end 1" of the tube 1. From this cylinder 7 there departs theends 6'a of the flexible elements 6, 6a. There may be any number ofthese elements: four are shown in the figure. At their other end 6"a,the elements 6, 6a are connected together in a cylinder 8 extended by anogival head 4. v The operation of this device is easy to understand:when the head 5 of the cable is pulled and moved away from the 'head 2of the cable, as shown in Figure 1, the cable 3 pulls on the cylinder 7and consequently on the flexible elements 6, which are forced to drawtogether and enter the tube 1 until the small cylinder 8 enters the tubein turn, the base of the ogival head 4 abutting against the edge 9 ofthe tube.

It is in this position that the instrument is introduced into thepassage in which the body to be extracted is located. For example, ifthe body is a ureteral calculus, the instrument is introduced, throughthe intermediary of a cystoscope, into the urethra 12, passes throughthe bladder 13, 14' and enters the ureter 14 by way of opening 15. Owingto the small diameter of the instrument, it is easy togo beyond thecalculus, so that the end of the instrument is located above thecalculus 16 (Figure 4);

The head 5 of the cable is then pushed back towards the head 2 of thetube in the direction of arrow 10. The cylinder 7 is pushed into thetube end, causing a movement of ogival head 4 in the direction of arrow11, and the elements 6 emerge from the tube and spread apart by reasonof their elasticity, as shown in Figures 2 to 5. It is then endeavouredto grip the calculus or other body by withdrawing the instrument. Duringthe movement of descent, the basket formed by the elements 6 spaced onefrom the other imprisons the calculus. When this has been done, the head5 of the cable is pulled again and this tends to close the elements 6 onthe body 16, which is thus imprisoned and firmly held. It only remainsto Withdraw the whole instrument gently to bring with it the calculus'16 to be extracted.

In practice, it has been found that it is not even necessary to causethe closing action by acting on the flexible control cable, because theWall of the ureteral duct exerts on the elements 6 a pressure sufiicientto keep the calculus imprisoned between the said elements.

Although the form of embodiment according to Figure 3 gives verysatisfactory results, the form of embodiment according to Figure 5 iseven more advantageous because, by reason of the helical form of theelements 6, 6a, it enables the body 16 to be gripped much more reliablyand to be held more effectively. In fact, when the Wires, such as 6,each take the form of a plane curve, they are liable to slide along thebody 16, whereas this disadvantage is obviated by means of the helicalelements, which grip the body progressively and, as it were, screwthemselves around it.

,1. M 2,948,626 1 i a 7 i Itis clearly stated the forms of embodimentwhich have just been described and which are shown in the figures areonly examples of construction, to which the invention is in nowaylimited. On the contrary, it comprises all'formsof embodiment,whatever may be the na-, ture and dimensions thereof. In particular, ashas been said, the number, length, thickness and profile of the flexibleelements may be chosen at will as a function of the aim to be achieved.The helical curve which the spread elements adopt may likewise have anypitch and answer any geometrical definition. The nature of the materialsof which the instrument is made may also be chosen at will.

, I claim:

1. A surgical instrument for extracting substances from a passage of abody, having an expansible portion comprising a plurality of flexibleelements of helical form, means controlling the expansion of saidexpansible portion comprising a flexible tube containing operating meansfor said expansible portion, said operating means including a cylinderslidable to different positions within said flexible tube, saidplurality of flexible elements being fixed to said cylinder, saidflexible elements in one position of said cylinder being confined withinsaid tube and being free of said tube when said cylinder is moved toanother position.

2. A surgical instrument for extracting substances from a passage of abody, having an expansible portion comprising a plurality of flexibleelements of substantially helical form, means controlling the expansionof said expansible portion comprising a flexible tube containingoperating means for said expansible portion, said operating meansincluding a cylinder slidable to difierent positions within saidflexible tube, said plurality of flexible elements being fixed to saidcylinder, saidflexible elements in one position of said cylinder beingconfined within said tube and being free of said tube whensaid cylinderis moved to another position, and a member having a cylindrical portionadapted to be received within the end of said flexible tube, saidflexible elements being secured to said cylindrical portion.

3. A surgical instrument for extracting substances from a passage of abody, having an expansible portion comprising a plurality of flexibleelements and means controlling the expansion of said expansible portionincluding a flexible tube containing operating means for said expansibleportion, said operating means including a cylinder slidable to differentpositions within said flexible tube, said plurality of flexible elementsbeing fixed to said cylinder and being composed of metal having acoating of plastic material resistant to sterilization temperature, saidflexible elements in one position of said cylinder being confined withinsaid tube and being free of said tube when said cylinder is moved toanother position.

4. A surgical instrument for extracting substances from a passage of abody comprising a flexible tube, an expansible portion including aplurality of flexible elements normally spreading apart and effectivelysecured together at the two ends thereof and operative to be retractedand confined within said tube essentially over the entire extent betweensaid two ends in one position thereof corresponding to the retractedposition and being free of said tube in another position thereofcorresponding to the exposed position, each of said flexible elementsbeing so constructed and arranged as to assume a substantially helicalshape when spread apart and means for controlling the expansion of saidexpansible portion including operating means extending through said tubeand means slidable within said tube effectively connecting saidoperating means with only the ends of said flexible elements disposednearer said tube-to seleetively move said expansible portion includingsaid flexible elements into said one position or into said anotherposition.

5. A surgical instrument for extracting substances from a passage of thebody, having an expansible portion comprising a plurality of normallyspread-apart, flexible elements each of which has a three-dimensionalspiral form when said portion is in an expanded position, meanscontrolling the expansion of said expansible portion comprising aflexible tube containing operating means for said expansible portion,said operating means including a cylinder slidable to differentpositions within said flexible tube, said cylinder being fixed to saidplurality of elements, said flexible elements in one position of saidcylinder being confined within said tube and being free of said tubewhen said cylinder is moved to another position, and a member having acylindrical portion adapted to be received within the end of saidflexible tube, said flexible elements being secured to said cylindricalportion.

6. A surgical instrument for extracting substances from a passage of thebody, having an expansible portion comprising a plurality of normallyspread-apart, flexible elements, each of said flexible elements being soconstructed and arranged as to assume a three-dimensional spiral formwhen said expansible portion is in an expanded position, meanscontrolling the expansion of said expansible portion comprising aflexible tube containing operating means for said expansible portion,said operating means extending through said tube and including acylinder slidable to different positions within said flexible tube, saidflexible elements in one position of said cylinder being confined withinsaid tube and being free of said tube when said cylinder is moved toanother position, the portions of said plurality of flexible elementsadjacent the end of said flexible tube when the flexible elements are insaid another position being secured within and by said cylinder, acontrol member attached to said cylinder extending through said flexibletube and slidable therein, and a member having a first part adapted tobe received within the end of said flexible tube when said flexibleelements are in said one position and a second part of larger diameterthan said first part abutting the end of said flexible tube when saidflexible elements are i in said one position, and the outermost ends ofsaid flexible elements being secured within and by said first part. 7. Asurgical instrument as defined in claim 6, wherein said flexibleelements are wires.

8. A surgical instrument according to claim 6, wherein said flexibleelements are bands.

References Cited in the file of this patent UNITED STATES PATENTS OTHERREFERENCES V. Mueller & Co. Catalogue 1938, page 292. in Division 55.)#GU-1642.

